Planning for Advanced Heart Failure

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Plan for peace of mind

An important part of shared decision-making in advanced heart failure is to clarify what you would want done when future events occur – including unexpected ones. Would you want a feeding tube? CPR? Would you want a tube placed down your throat to help you breathe?

The process of anticipating future scenarios and communicating your preferences is called advance care planning. It allows you to speak for yourself, even when you can't. It also helps your family make decisions according to your priorities.

Advance care planning involves:

  • Learning what health decisions you may have to make in the future
  • Thinking about your goals and preferences
  • Discussing what is important to you with your family and doctor
  • Documenting your plan in an advance directive, which can be updated if your wishes change

Palliative care

The goal of palliative care is to help patients live better by relieving symptoms and improving quality of life. Receiving palliative care, which isn't the same as hospice, doesn't mean you have to stop heart failure treatment. Palliative care can be provided when you need it, no matter the stage of illness.

Palliative care can provide:

  • Relief of pain and symptoms of heart failure
  • Emotional and spiritual support for you and your family
  • Help with making complex treatment decisions
  • Assistance with practical issues, such as advance directives or insurance
  • Support services for caregivers, such as respite care and grief counseling

Members of the palliative care team may include a doctor, nurse, social worker, chaplain, physical therapist, occupational therapist, dietitian and psychologist. These professionals can become a part of your healthcare team, just like your cardiologist and other physicians.

Care at the End of Life

Talking about and actively preparing for end of life can be upsetting. Even though you can't control when you die, you can make plans to control many aspects of the dying process.

In advanced heart failure, care options at the end of life include:

  • Turning off an implantable cardioverter defibrillator (PDF): Electrical shocks from an ICD can cause unnecessary suffering for patients and families near the end of life. The shock function of an ICD can be deactivated, or you may choose not to receive a new battery when the current one expires.

    Watch an animation of an ICD.
  • Turning off a mechanical heart pump: A decision must be made about when to turn off a left ventricular assist device (LVAD) at the end of life. A thoughtful discussion and careful plan about when you would want to discontinue LVAD support should be part of the decision-making process before the device is implanted.
  • Hospice care: When the transition is made from quantity of life to quality of life, hospice care provides comfort and support to advanced heart failure patients and their families. Hospice care services are often provided in the home by a team that includes a doctor, nurse, therapist, social worker and other professionals. They work with you and your family to develop a personalized care plan based on your goals and needs.
    Hospice care services may include:
    • Medical care to manage symptoms (the hospice nurse and doctor are on call 24 hours a day to provide care)
    • Emotional and spiritual counseling
    • Physical and occupational therapy to help a person develop new ways to perform daily tasks, such as getting dressed, taking a shower and moving safely around the house
    • Art therapy, music therapy and other complementary therapies
    • Respite care to provide a break for caregivers and families
    • Home health aides to help with bathing, grooming, eating and other personal health needs
    • Help with insurance, legal documents and other practical issues
    • Trained volunteers who provide a variety of support services, such as babysitting, running errands and preparing meals
    • Bereavement support and counseling for caregivers and families

Making plans for how you want to spend your remaining life can be tough. But difficult discussions now can simplify difficult decisions later.

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